Healthcare Provider Details

I. General information

NPI: 1730097353
Provider Name (Legal Business Name): 982 FULTON DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 FULTON STREET SUITE B
BROOKLYN NY
11238
US

IV. Provider business mailing address

982 FULTON STREET SUITE B
BROOKLYN NY
11238
US

V. Phone/Fax

Practice location:
  • Phone: 646-504-9519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NIEKU MANSHADI
Title or Position: OWNER
Credential: DDS
Phone: 949-293-7357